Inquiry checklist -- be prepared when contacting First Coast

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Home ► Contacts ► Inquiry checklist -- be prepared when contacting First Coast

Last Modified: 4/19/2024 Location: FL, PR, USVI Business: Part A, Part B

Provider inquiry checklist

Be prepared when contacting First Coast

In accordance with the Health Insurance Portability & Accountability Act (HIPAA), First Coast is entrusted to secure protected health information (PHI) of all individuals. Access to patient and claims information requires an authentication process.

Use the following checklist to ensure you have the authentication information required (right column) for the specific type of inquiry indicated (left column). Separate checklists have been provided for inquiries performed through our interactive voice response (IVR) system and for those made through our provider contact center, whether in Florida (FL), Puerto Rico (PR), or the U.S. Virgin Islands (USVI).

IVR Inquiries

Part A (FL, PR, USVI) -- 1-877-602-8816

Part B (FL, PR, USVI) -- 1-877-847-4992

For all inquiries identified below, the National Provider Identifier (NPI), Provider Transaction Access Number (PTAN) and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required.

IVR Inquiry type	Information required
Claim status	• Patient’s last name -- first 6 letters • Patient’s first initial • Patient’s Medicare ID • Date of service (DOS)
Clerical reopening (claim adjustment) -- single line (Part B only) Click here for additional details • Change date(s) of service (DOS) and quantity billed (if desired) • Add, change, delete modifier(s) (Exceptions: modifiers 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU) • Note: Application of GV or GW modifiers (hospice) can be applied to an entire claim • Change diagnosis code • Change procedure code and billed amount (if desired) • Change quantity billed and billed amount (if desired) • Change ordering or referring provider information • Entitlement reopenings (History corrections) • Change in entitlement effective dates • Update regarding patient’s primary insurance -- Medicare secondary payer (MSP) situations • Medicare Advantage (MA) plan involvement update • Update to patients records	• Caller’s name • Caller’s 10-digit telephone number • Patient’s Medicare ID • Patient’s first initial • Patient’s last name -- first 6 letters • Patient’s date of birth (DOB) • Internal Control Number (ICN) of claim requested • Date of service (DOS) • Item(s) or service(s) at issue • New or revised information
Patient’s eligibility	• Patient’s last name -- first 6 letters • Patient’s first initial • Patient’s Medicare ID • Patient’s date of birth (DOB)
Provider enrollment application status Look up your enrollment status	• Correspondence Control Number (CCN) -- 15 digits

Access the IVR operating guide for:

• Florida / U.S. Virgin Islands

• Puerto Rico

Provider Contact Center

Part A: FL, USVI -- 1-888-664-4112 PR -- 1-877-908-8433

Part B: FL, USVI -- 1-866-454-9007 PR -- 1-877-715-1921

For all inquiries identified below, the NPI, PTAN and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required.

Customer service inquiry type	Information required
Appeals request – status Claim information (excluding status) Clerical reopening -- (Part B only) Speak to CSR for reopening previously adjusted claims. • Note: Reopenings cannot be performed on: • Pending claims • Non-assigned claims • Certain drug and drug administration codes • Requests related to modifiers 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU For claim types listed above, consider a redetermination.	• Patient’s last name • Patient’s first name or initial • Patient’s Medicare ID
Clerical reopening -- (Part B only) • CSRs may only assist on certain claims that are not able to be reopened via the IVR.	• Patient’s Medicare ID • Patient’s last name • Patient’s first name/initial • Patient’s date of birth (DOB) • Date of service (DOS) • Item(s) or service(s) at issue • New/revised information
Patient’s eligibility issue (if not available through IVR)	• Patient’s last name • Patient’s first name/initial • Patient’s Medicare ID • Patient’s date of birth (DOB)
Provider enrollment issue (excluding status) Only contact person on application may call to discuss issue. Look up your enrollment status	• Correspondence Control Number (CCN) -- 15 digits • Copy of application and any correspondence sent

View additional information concerning the provider contact center.

Source: CMS IOM Pub. 100-09, Chapter 6, Section 80.1 and 80.2.1

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